Ebola

“If I get a call about smallpox from the ER I’m not coming in,” an Infectious Disease doctor said to a colleague in the hospital where I was working. It was the early days of 9/11 and anything seemed possible.

“Are you all OK with providing care for Ebola patients?” our section chief asked. Our ICU is the designated unit to care for all adult patients suspected of having Ebola in our system. We would be the ones donning the protective gear, following infection control protocols and caring for any potential patients.

Ebola. “It’s like the early day of AIDS,” the older doctors say. A time when people died of AIDS, before it was a chronic illness to be managed. A time when surgeons refused to operate on people with AIDS, a time when patients were turned away from Emergency Rooms, a time when people were deathly afraid.

More recently, the threat was the H1N1 influenza. The flu kills thousands of people every year, but the H1N1 killed healthy, young people. They were the ones filling our ICUs. I remember putting on the protective gear to enter the room of a young pregnant woman with H1N1. It was daunting. The hand sanitizer, the gown, the gloves, the mask, turn on the air circulator, deep breath and open the door. And all through that I tried to think of only the small details of each task, so as not to think about the young woman fighting for her life. Twenty-two weeks pregnant, intubated, with her family in shock, did she already have a toddler at home? I tried not to think of the what ifs, of whether she would make it through, as we kept her on the maximum ventilator settings, gave her the maximum oxygen, and hoped that it would be enough. At least for today, day by day, let it be enough. Let her not die on my watch.

Is any doctor really “OK” with taking care of someone like her? Someone dying of a communicable disease, someone who doesn’t have an obvious susceptibility to feed our delusion that it wouldn’t affect us too. What would I want others to do if it were me in that room, dying, literally dying for help? Would a nurse or a doctor refuse to care for me? Would they cite fears of catching this dangerous illness and bow out? And in the end, would that save them? Would they go home and never get the flu? Or would they catch it from someone out in the grocery store, their kid at school, the guy on the bus?

“Can anyone think of an example where doctors have to be brave?” a lecturer asked us in medical school. We had volunteered examples of situations where firefighters and police officers had to be brave. I honestly drew a blank when he asked, and from the quiet that fell over the large lecture room, I suspect my classmates had as well. We were training in NYC and within a year we would be drawing blood on patients of all sorts, patients who had HIV, and patients who had hepatitis B (which turns out to be more infectious than HIV). At no time did I nor any of my classmates refuse to treat a patient. Even as medical students, when we weren’t absolutely essential, when we could’ve stepped back, and let the intern, or the resident, or someone other than us take over, even then we didn’t. It’s your turn, your patient, you don’t take stupid risks, you don’t recap needles, you wear gloves, but on you go.

Did any firefighters running into the burning WTC towers pause to object? I doubt it.

In the end, we are in this together. As much as we’d like to pretend otherwise, to imagine that with enough foresight, enough money, enough power, enough something, we could isolate ourselves from the misery that befalls the rest of humanity, the truth is, we cannot. We are a social species, we only survive because we are together, and our survival depends on each person doing their part. We each take risks. And the risks don’t always seem heroic – they are mundane and we take them because they are part of our jobs. In NYC, it turns out, the riskiest job is being a taxi driver.

We take risks in our jobs, because we have been trained what to do in these circumstances. Because if we do not do our jobs, then things would be likely to be worse for many more, because, on some level, we understand that there are things bigger than us – that just like we expect the firefighters to show up at our door and come into a burning house for us and our children, others expect us to be there when they come in with a fever.

I can’t pretend to know whether we will even see an Ebola patient in our ICU, but knowing that people will show up to work and do what needs to be done matters. It matters because if I don’t show up to work I am putting my colleagues at risk, if the nurses don’t show up, they increase the risk for their colleagues and everyone else. If we don’t have the right number of people taking care of patients, it is less safe for the patient, and for the staff. It isn’t bravery, it’s part of living in a society.

I read the updates from a friend in the CDC who flew to Liberia. I think of the risks she is taking. Would I leave my family to get on a plane to Liberia? And yet when she writes, she sees the risks others are taking. People in the US are worried but over five thousand people have died in Africa. Support Doctors without Borders and Samaritan’s Purse, she urged us, those are the people on the ground making the most difference. It seems selfish to wring our hands and fret and offer so little help to those who need so much more.

Is the point that we are exaggerating the risks and therefore we should continue to be present and do our jobs or is the point that we should be present to do our jobs no matter what the risk? Both. The risk of Ebola in the West is exaggerated, but that is irrelevant because we should be ready to treat patients anyway. From here I can’t judge those in different circumstances, those healthcare workers struggling to help without adequate protection themselves, where modern infection control practices are not available, where little treatment is offered. But if a patient gets admitted to our hospital with Ebola, I will be at work and I expect all my colleagues will as well. We shouldn’t panic. Or at least, we shouldn’t panic about the wrong thing. Let’s not trample each other to death trying to escape a threat that never quite arrives.

No one ever came to the New York Emergency Rooms with smallpox after 9/11. The treat of bioterrorism never materialized. In fact, the hospitals were largely empty as we waited and waited for survivors to come. Then we went to ground zero and saw that there were few who were actually injured. There were the thousands who had perished in the buildings, and the others who had walked away. And yet it mattered that the doctors and nurses and other hospital staff were there willing to help. It mattered to the firefighters who were hurt while trying to rescue others. We were there, and we were ready, and sometimes, that can be enough.